Ask The Doc

Q: I’ve heard that winter is the best time to treat the spider veins on my legs. Is this true and if it is, why?

A: The first thing that we have to do with veins on the legs is to find the source and exclude large vein disease. This can only be done with a fully ultrasound examination which is done in the office. The reason for doing veins in the winter is just for comfort. If there are larger veins, it will be necessary to wear compression stockings after the injections. For small veins, there is always a small risk of bruising and staining of the skin. This can take a few days to weeks to resolve so people prefer to do this when their legs are concealed more and not in shorts. So, yes, this is coming up to a good time to treat your veins so that you are ready for next summer.

Q. I have a lot of little red blood vessels on the sides of my nose. It makes me look like I have a cold all the time. What can I do to get rid of these things?

A. These little blood vessels are very common, especially in fair skin. We treat these with a laser that is used for treating blood vessels. This laser obliterates the blood vessels without damaging your skin. Unfortunately, these little vessels around the nose can be very stubborn and make take as many as three or four treatments to get rid of them. Even then, we continue to grow new ones and the treatment may need to be redone in the future. Consider it maintenance, like having your hair done.

Q. My mother had terrible trouble with leg veins and had them stripped and injected. I am only in my late 20s but already starting to see big veins popping out on my calves. Should I be starting treatment this young? C.R.

A. One of the big misconceptions is that varicose veins are a condition of old age. Quite the opposite is true. There is an old saying that ‘varicose veins are caused by the improper choice of grandparent’. In other words, this is an inherited problem and will often present in very young life, even early teenage life. The most important thing, if you have a family history and are seeing big veins, is to have a proper evaluation of your veins which includes a physical examination and ultrasound examination, both of which I do in my office. Then, if there are faulty veins, we can lay out a treatment program for you which may just be keeping a watch on the veins or may require treatment.

Treatment for varicose veins has come a long way and is much more precise than it was 20+ years ago so you should not be fearful of checking your veins out. Just call for a vein consultation at my office to have this done.

AGING SKIN

Q: I’m getting a lot of brown spots (age spots) on my face that I really don’t like. What’s the best way of getting rid of these?

A: First of all, not all brown spots are created equal. It sounds like you are talking about sun damage and the brown spots that are created. Once we check to make sure these are all benign, we then have to try to ascertain what kind of pigmentation this is, shallow or deep. The depth of this pigmentation will be a deciding factor in which treatment to recommend. This could be laser, laser-like energy (Intense Pulsed Light) or the use of chemicals. Some pigmentation is very stubborn but most can be removed. Of course, good skin care after, particularly sun protection is very important.

Q. I have an overly oily forehead and scalp. Is there a way to permanently zap the glands or is there an oral medicine to stop the over production? I used to be onaccutane about ten years ago. Acne isn’t really a problem anymore, but I have oily skin no matter how much I wash my face.

A. You state that you have used Accutane which can help but has some side effects. One other option that may help is resurfacing with a laser. Fortunately, the newer type of what is called fractional resurfacing also works well. Fractional Resurfacing is where only small areas of the skin are injured with the laser, leaving a lot of uninjured skin in between which results in only a 2-3 day healing period rather than 7-10 days. The outcome can give very nice results for reducing the oiliness. I would need to explain the process to you so feel free to call for a complimentary consultation.

Q. Spots – thin skin – veins – I hate the look of my hands! Is there anything that can be done to reverse the signs of aging?

A. I get many questions about hands. Our hands show the same signs of aging that our face does with loss of elasticity and volume. As a result the skin looks thinner and the veins and tendons show through. We also get the sun damage with brown and red spots showing on the skin. So, we can do a ‘hand-lift’! We can treat the skin discolouration with light energy like lasers giving the skin a younger appearance. The skin can then be plumped up with fillers to provide more volume which hides the veins and the tendons. ‘Voila’ – you will have younger looking hands to match your younger body and face. Come in and talk to me about what can be done.

Q. I have my Mother’s skin (she’s from Scotland). So, I have a lot of redness and small blood vessels on my cheeks, nose and even my chin. As I am getting older, it seems to be getting redder and even a small glass of wine will make my face ‘shine’. Can lasers do anything about this? C.McK.

A. In the Bow Valley, we see a lot of this type of skin (Canmore and Banff are both Scottish towns so obviously pioneered by Scots). One of the most successful treatments is Intense Pulse Light or IPL. This is a type of laser but has a much wider light spectrum. It is very successful at removing the redness that people whose heritage is Celtic or Northern European. The recovery time from this treatment is minimal, with only the slight possibility of some swelling and rarely a little bruising (if the blood vessels are large). So, it can be done almost anytime. By the way, IPL at the same time removes the brown spots on the skin from sun damage so there is an extra bonus.

Q. I have been reading about your new equipment, the Bodytite. I am quite slim but, after 3 babies, I am left with slack skin on my tummy which I hate. Will this treatment help?

A. very much so. The Bodytite uses a form of energy called radio frequency, which heats up the skin tissues very safely. This causes contraction and tightening as well as stimulating new collagen cells in the skin which continue to improve the tightening effect over the following 2-3 months. Very nice results can be obtained treating the Mummy Tummy. You will need to see me first, however, so that I can properly explain the procedure for your own safety.

Q. I saw on the MediSpa Facebook page that you were introducing equipment called BodyTite for tightening neck skin. What is this and are you doing it?

A. I have just had the opportunity to train on this equipment with Dr. Stephen Mulholland in Toronto. He has said that BodyTite gives the best results next to a surgical neck or facelift! It uses radio frequency energy to tighten the skin. The way that this energy is delivered is what makes it special as the heat delivered to the skin is very precisely controlled but allowing a remarkable amount of tightening to occur. There can be some swelling and bruising for a few days after treatment but the results can be long lasting. I should be offering this treatment by February and I will be putting information about it on my webpage www.canmoremedispa.com in the very near future.

Q. I consider myself to be reasonably fit and certainly not overweight. In spite of working hard on my tummy, I have this loose skin around and under my belly button that I have not been able to get rid of since my two children were born (last one 5 years ago). I hate the look of it in a bikini so I will often prefer to wear a full suit. Is there anything that can be done for this?

A. Up until very recently, your only choice may have been surgical as this skin will not tighten with exercise. Brand new on the market, however, is a new device called BodyTite that will create dramatic tightening of the skin. The recovery time is quite short, especially if compared to surgery. You may be very happy to get back in to your bikini.

Q. I am in my 50s and, like my Mother, I am starting to get a lot of loose skin under my chin and neck. This is driving me crazy as it makes me look so old. I keep wearing clothes with high necks or scarves to hide it. Is there anything that can be done for this?

A. This, unfortunately is always a difficult area to treat as the skin on the neck is so thin that many of the tightening procedures that we use cannot be safely used on this skin for risk of injury. There are special Botox injections that we do that can improve the wrinkles. PRP (Platelet Rich Plasma) injections, which use your own blood products, can create slight improvement. One of the most exciting things, short of surgery, is NeckTie. This is a brand new technology which I have just obtained, which uses radio frequency to tighten the skin. The results are quite dramatic and are much easier than surgery. The recovery time is minimal but can expect a little swelling or bruising for a few days.

Q. The pores on my face are huge, or at least I think so. Especially over my nose and cheeks. I am even getting some small white bumps forming on the pores. Can anything be done about this? C.S.

A. Large pores are usually due to inherited skin type. We see this more in fair skin of Celtic or Northern European heritage. Although you can’t change your genes, we can improve the appearance of the pores. Intense Pulse Light (IPL) is a type of light wave energy that is particularly good for reducing redness and brown spots on the skin. At the same time, it will decrease pore size to some degree. A more aggressive way of managing this is fractional or full field resurfacing. This has a bit longer recovery time but can make a very significant difference to the quality and appearance of the skin and is particularly good at reducing pores. Ongoing skin maintenance at home, after the treatment, will consist of an exfoliating agent such as a glycolic acid cleanser or a retinoic acid cream in the Dermalogica or Skin Tx line available at The Canmore Medispa.

Q. You keep talking about the difference between sunscreens and sunblocks but I am not sure that I have really been able to understand the difference. I have always used a day cream with SPF 15 that I put on in the morning. Is this not good enough?

A. At least you are doing something to protect your skin from early aging effects from the sun. Blocks and screens work differently. Sunscreens include chemicals that help the skin to absorb the damaging effects of the sun, particularly UVA. They should, however, be applied at least 30 minutes before sun exposure to work into your skin and need to be reapplied about every 2-3 hours to maintain their effect. Sunblocks contain minerals like iron, titanium, zinc and others that block the sun’s rays from your skin. They don’t need to be applied early and will usually last on your skin a lot longer. They also protect against the damage from UVA and the sunburn effect from UVB. So, it is a matter of personal choice, but we recommend the mineral blocks for superior protection.

Q. I saw your answer last week about the sunblocks and sunscreens. Where do I get sunblocks as I don’t see them that often in stores besides the shelves full of sunscreens?

A. Many years ago, sunblocks were quite popular because they looked like ‘war paint’. That was the white stuff that people would apply to their nose or other parts. Then they came out with wild fluorescent colours. Then, that died. This, though, was zinc oxide cream which worked well but nobody wanted to walk about with a solid white face. The mineral blocks then came out from some of the high end makeup companies. They used special techniques to disguise the whitening effect and are applied like a makeup to the face. The good ones require colour matching to your skin tone. But, even for men, when applied with a brush and sprayed, it is completely inconspicuous yet gives great protection. That is what I wear in Mexico or on the golf course. So, you will have to find them in a high end salon or medical spa.

Q. I am in my fifties and noticing a lot of brown marks on my face and many fine wrinkles on my cheeks and around my mouth. I don’t want to have surgery. Is there anything else that can help? J.S.

A. Sometimes, if the damage is severe, surgery is the only option. However, we can improve the skin significantly with laser resurfacing. By breaking the laser beam up into smaller beams, resurfacing can give great results in the colour and texture of the skin with a much shorter downtime. This is called fractional resurfacing. But, because it only treats a ‘fraction’ of the skin, it may require more than one treatment. For more severe wrinkles, like those that we get around the mouth and eyes, we can still do full resurfacing which does give beautiful results but has more recovery time. So, don’t give up – we can help.

Q. Now that I have been out in the sun a bit, I am noticing that I am getting more and more brown spots as the years go by. Do I have to live with these as they do make my skin look older than I feel? M.H.

A. Summer is great. We all feel the benefit of the warm sun’s rays but, of course, there is the downside of sun damage causing skin aging that comes along with it. Those brown spots are a sign of sun damage and are usually not harmful but can be cosmetically unappealing. At the end of Summer, you want to think about treating your skin with IPL (Intense Pulse Light) as this is usually very effective at treating not only the brown spots, but improving the sun damage below the skin. This will make your skin look and feel much younger. Depending on the amount of damage, we may recommend one or two treatments. See us for an opinion.

Q. I am in sales, so my hands are always on display. I am 48 and healthy, but my hands just look old. I have tried all sorts of creams but nothing seems to improve the wrinkly looking skin. What can I do? M.E.

A. There’s a saying that, if you want to know a woman’s age, look at her hands. Often we neglect our hands as we are not seeing them in the mirror all the time but we can treat the hands the same way as we do the face. Discoloration is common on the hands due to sun exposure so, removing the uneven brown and red spots with IPL (intense pulsed light) can remove the sun damage.

If the skin is still wrinkled and thin, then we can improve this with a resurfacing laser or with the injection of fillers which plump up the tissues a bit. We can use fillers like Juvederm or Selphyl, (the vampire lift product), both of which can give very nice results. Let me see your hands and I can advise you on the best approach.

Q. I have quite a lot of brown spots on my body but one of them seems to have grown bigger recently. Should I be concerned and what should I do? K.T.

A. The quick answer is HAVE THEM CHECKED. The more moles or brown spots that you have obviously increases the likelihood of one of them changing into a form of cancer. Melanoma, the most frightening of the skin cancers, can be very sneaky in that it can occur in a pre-existing brown lesion or can start from fresh. Also, it need not be only in a sun exposed area so even places like the feet or the groins need to be watched.

Any skin lesion that changes size, shape or colour should be considered suspicious and must be checked. This can be done by a Doctor with experience in examining these lesions and this is often improved by using special tools such as a Dermascope, that allow much more accurate assessment. If there is any doubt, a biopsy will be taken for pathological examination. So, again, HAVE THEM CHECKED!

Q. I hear a lot of talk about facial SKIN PEELS. Can you give me a bit more information on what they are? L.S.

A. Neat question as I have just written an article on peels in my newsletter. Peels can be very mild with low concentration fruit acid peels such as glycolic acid (often called a ‘lunchtime peel’). With this, you don’t actually peel, rather exfoliate some of the surface dead cells so there is very little recovery. Slightly stronger peels are amazing for treatment pigmentation and acne and will cause some flaking and peeling and possibly slight swelling for about 48 hours.

Microdermabrasion is another form of peeling or exfoliating the skin with no recovery time to speak of. Lasers can be set to remove very precise thickness of skin. A MicroLaserPeel (MLP) will remove as little as 4 microns (0.04mm) of the surface of the skin which is usually very well tolerated and will cause slight redness for about 36 hours. A very quick answer to your question but I hope that it helps.

Q. How can I improve the tone and quality of my skin? I use good products regularly, cleansers and moisturizers, but my skin still looks flat and dull. I am in my early 40s.

A. As we get older, because of aging and sun damage, the dead cell layer thickness on our skin gets thicker. This has the effect of refracting the light when it hits our skin, instead of reflecting it as in young skin. You can improve this with the regular use of a glycolic or retinoic (vitamin A) cream but sometimes you have to be more aggressive. We can help with facial chemical peels or microdermabrasion. Intense Pulse Light (IPL) treatments have the added effect of repairing deep sun damage. Also, Micro Laser Peels (MLP) can significantly improve the quality of your skin. All these procedures can be explained to you in a (free) skin consultation in our office. Call for an appointment.

Q. I recently had an IPL (Intense Pulse Light) treatment and I am very pleased with the result. What is the best way for me to look after my skin so that I can make the most out of my investment?

A. IPL can make your skin look and feel significantly younger. After, you want to protect your skin from the sun’s damage as much as possible – try a good quality mineral make-up such as Jane Iredale. Dermalogica (one of our line of skin care products) provides exfoliants and moisturizers that will also keep your skin healthy and young looking. I also recommend a mild facial “peel” every 2 months (peel is not a good term as it is really an exfoliation – no down time) and/or a microdermabrasion. Check our packages at the MediSpa. Peels are an excellent and affordable way to “Clearly Beautiful Skin”.

Q. I’ve been hearing a lot about Fractional Lasers for treating acne scars and wrinkles. What’s it all about and are the treatments successful?

A. This laser resurfacing procedure is used to improve a wide variety of skin conditions by creating thousands of microscopic channels in the skin surrounded by areas of healthy untreated skin. The zones of untreated skin invigorate the body’s natural healing process and the treated areas stimulate the production of new collagen. The ProFractional Laser treats conditions such as wrinkles and fine lines, post traumatic scars, freckles, age spots, aging and sun damaged skin, sun spots, and acne scars. This means beautiful results for these conditions with very little ‘down time” (2-3 days). We have already seen dramatic results with this laser treatment. Call for your consultation with Dr. Balharry.

Q. I hear a lot of talk about facial SKIN PEELS. Can you give me a bit more information on what they are? L.S.

A. Neat question as I have just written an article on peels in my newsletter. Peels can be very mild with low concentration fruit acid peels such as glycolic acid (often called a ‘lunchtime peel’). With this, you don’t actually peel, rather exfoliate some of the surface dead cells so there is very little recovery. Slightly stronger peels are amazing for treatment pigmentation and acne and will cause some flaking and peeling and possibly slight swelling for about 48 hours.

Microdermabrasion is another form of peeling or exfoliating the skin with no recovery time to speak of. Lasers can be set to remove very precise thickness of skin. A MicroLaserPeel (MLP) will remove as little as 4 microns (0.04mm) of the surface of the skin which is usually very well tolerated and will cause slight redness for about 36 hours. A very quick answer to your question but I hope that it helps.

PROLOTHERAPY / PRP

Q. A few weeks ago, I saw you answer a question about painful joints. I am only 47 but have been active in sports and had some injuries. This has left me with what they call degenerative changes in my knee which is not bad enough for surgery but is really interfering with my activity. Can you go over the options?

A. Working in Canmore, this is a problem that I see very frequently. We live in an active community so wear and tear on our bodies is common. Degenerative (arthritic) changes in the knee, or any joint, can come about from injury. As for treatment, sometimes pain killers work, or wearing what is called an off-loading brace. Now, you asked about injections. One type of injection is hyaluronic acid which lubricates the joint and lasts about six months. I also do Prolotherapy in joints, which is an injection of Dextrose which stimulates healing. The other option that I offer people is PRP (Platelet Rich Plasma) which uses the healing cells from your own blood to stimulate healing in the joint. (check out Tiger Woods, Hines Ward and others). None of these treatments are guaranteed to work but they may give relief and allow you to get back to some exercise. Next week, I will talk about other joints.

A. Last week I was talking about treating joints and focused mostly on the knee. Of course, other joints respond in the same way. Shoulders are frequently injured but more commonly this affects the muscles around the shoulder (the rotator cuff). Rotator cuff tears may need orthopaedic consultation and surgery but often they are not surgical. PRP (Platelet Rich Plasma) injections can often help to repair these injuries. Bursitis of this joint can be treated with a small dose of cortisone injected in to the bursa. Hips are another joint that can be successfully injected with hyaluronic acid gel, dextrose or PRP.

These injections are more successful when guided by ultrasound, available in my office. Many of the small joints like hands can also be treated by injection which will often give better and quicker results than taking anti-inflammatory pills. So don’t let painful joints hold you up – there may be options that could benefit you. I have been successfully treating joints by injection techniques for 30 years.

Q. what is PRP? I have a bad knee with what is called degenerative changes in my knee joint and I read that PRP can help. I know that it’s got something to do with using your own blood. Can you tell me more?

A. PRP is short for Platelet Rich Plasma. Some of your own blood is taken from you, just like have a blood test at the lab. The blood goes through a special process that takes about 20 minutes, which separates your blood cells. The Platelet Rich layer, contains the cells that promote healing. This is then injected back in to you, depending where the problem is. That could be a joint, like your knee or ligaments like rotator cuff injuries in the shoulder or Achilles tendonitis in the ankle. The strong healing response will help to repair the area and, hopefully, treat the problem. Because of the healing properties, it can also be used cosmetically to improve wrinkles such as those under the eyes, the hands and the chest. Couldn’t be more natural, could it?

Q. A week or so ago, I read your answer to a question about PRP injections. I have also heard of prolotherapy – are these the same things or are they different?

A. They are the same but different! Let me explain. Prolotherapy uses a dextrose (sugar) solution which irritates the tissues where it is injected, triggering off a healing response (Proliferation). PRP uses the platelets from your own blood which already have the growth factors and other healing factors concentrated in them. They are often used to treat similar injuries such as sprains and tears. Prolotherapy will promote healing but it takes longer and more treatments than PRP but it is less expensive per treatment. PRP is the better option for joints for treating things like osteoarthritis. I can help people to decide which is the better option for their particular problem.

Q. I have quite bad arthritis in my left knee. I have had injections of Durolane which can help but I have been reading about PRP. I have heard that this is something that you do. Can you tell me about it?

A. PRP is short for Platelet Rich Plasma. This treatment uses your own blood but separates the cells in the blood. We use the platelets as they encourage growth and healing. PRP has been used in surgery for about 20 years but recently has gained interest as a stand alone treatment for various injuries and also for treating arthritis. The platelet rich part of the blood is drawn off and this is what is injected into the area of concern, in your case the knee. Unfortunately, to date, there are no studies to assess the outcome so we can never guarantee the outcome. Many people have gained significant benefit from PRP injections. I do offer this treatment in the MediSpa, often using ultrasound to guide accurately in to certain joints like the shoulder for rotator cuff injuries. It is not for everyone but it is certainly worth looking at as a treatment.

Q. I injured my Achilles tendon 3 months ago and it is still giving me pain. A friend said to me that I should try PRP injections. What’s this all about? D.B.

A. PRP is short for Platelet Rich Plasma. This is a process where we take some of your own blood and centrifuge it in a special gel that separates the blood cell layers. We then draw off the layer that contains the platelets, stem cells and other healing cells. This is then injected in to the site of injury.

What this does is it stimulates a strong healing process at the site of injection. It can be used for many types of injuries such as knees, ankles, shoulders as well as possibly helping for arthritis.

This is a relatively risk free procedure which received media coverage recently when used by Tiger Woods and a couple of the Pittsburgh Steelers players, Hines Ward and Troy Polamalu. It is certainly worth considering for slow healing injuries.

HYPERHIDROSIS

Q. I really look forward to Spring and Summer BUT I also hate it because of my underarm sweating! I have to be so careful what I wear as my clothes quickly get quite wet and will stain from my antiperspirants. I have heard that Botox can help this. Is that true? S.E.

A. Absolutely true S.E. This is a problem that I see a lot of in my Office. Heavy sweating, also known as hyperhidrosis, is a surprisingly common problem but can be very embarrassing. Fortunately, a few simple tiny injections of Botox into the underarms can relieve this heavy sweating for often 9-12 months. This can literally change some people’s social lives.

The other nice thing is, for most people with extended health benefits, the cost of the Botox can be covered! You can’t beat that. The treatment only takes a few minutes for months of dryness.

Q. I have an embarrassing problem of sweaty armpits and wet hands. What can you tell me about the Botox treatments for this?

A. Botox is a wonderful treatment for excess sweating or hyperhidrosis. This condition can cause serious social and psychological problems.

The treatment takes only minutes, however the results can last for up to a year, sometimes even longer. And, what is even more exciting is that for most people, the cost of the Botox can be covered by insurance. All you have to lose is your sweat. Make an appointment with Dr. Balharry so that he can discuss your treatment and your cost coverage.

BOTOX

Q. I really look forward to Spring and Summer BUT I also hate it because of my underarm sweating! I have to be so careful what I wear as my clothes quickly get quite wet and will stain from my antiperspirants. I have heard that Botox can help this. Is that true? S.E.

A. Absolutely true S.E. This is a problem that I see a lot of in my Office. Heavy sweating, also known as hyperhidrosis, is a surprisingly common problem but can be very embarrassing. Fortunately, a few simple tiny injections of Botox into the underarms can relieve this heavy sweating for often 9-12 months. This can literally change some people’s social lives.

The other nice thing is, for most people with extended health benefits, the cost of the Botox can be covered! You can’t beat that. The treatment only takes a few minutes for months of dryness.

Q. I am in my early thirties and noticing already that I am getting strong frown lines on my forehead. I would love to do Botox but I’m a bit nervous about starting so young and also about the side effects. D.V.

A. Botox has been in the news a bit because of side effects. These side effects relate to large doses that are used for treating muscular conditions like cerebral palsy or back muscle spasm. Cosmetic doses are very small and very safe. Many people are now starting to use Botox earlier in life to prevent wrinkles forming.

There are published studies of people who have used Botox over more than 13 years with absolutely no side effects and reducing the effects of aging (studies on twins). In short, Botox is a safe product that can give lovely cosmetic results short term and long term.

Q. I have an embarrassing problem of sweaty armpits and wet hands. What can you tell me about the Botox treatments for this?

A. Botox is a wonderful treatment for excess sweating or hyperhidrosis. This condition can cause serious social and psychological problems.

The treatment takes only minutes, however the results can last for up to a year, sometimes even longer. And, what is even more exciting is that for most people, the cost of the Botox can be covered by insurance. All you have to lose is your sweat. Make an appointment with Dr. Balharry so that he can discuss your treatment and your cost coverage.

FILLERS

Q. I am a 35 year old male who has lost over 70 lbs. When I was larger, I looked quite young but since losing the weight, I really notice my face has aged – i.e. more hollow and deeper wrinkles. What options are there for me without looking like a wax –work model?

A. It is common when we lose weight to lose it in the face, particularly the mid face, creating the hollow cheeks that you are talking about. The best option is fillers. We inject fillers for this kind of problem, deep in the tissues, actually on the surface of the bone. This lifts your own tissues, (muscles, fat etc.) giving you back the fullness that you want. And NO – you will not look like a wax-work model, just your old self. The newer fillers can last 2 years or more so it is not something that you have to do often. A complimentary appointment with me can assess your needs and costs.

Q. I’m in my mid 40s and see my face just sagging, which I just hate. I’ve heard that fillers like Juvederm can help but I don’t want big fat lips and things. What should I do?

A. This comes up often in my practice. Unfortunately, fillers are often done badly, using way too much filler giving a grotesque appearance. Good technique uses fairly small amounts of filler in deep locations that actually ‘lift’ your own tissues. Knowing facial anatomy, this can be placed in the same location that your own tissue used to occupy, giving a very soft, natural look. This method restores your appearance, it does not give you a new appearance. Lips too can be very gently changed to show slightly more red and remove some of the lip lines. This often means small amounts of fillers placed in several different locations of your face to give a nicely balanced, soft, younger appearance. Do not be afraid of fillers as long as you see an expert injector to have it done.

Q. I’m in my twenties and have a bump on my nose that I do not like. I am a bit nervous about having surgery. Do you have any other suggestions? C.S.

A. Surgery on the nose can be very successful but, you’re right, many people are reluctant to make that step. Fortunately, we can make some changes to the shape of the nose with fillers. The newer fillers such as Juvederm, can be used on the nose to make changes to the shape. Bumps or bends can effectively be reshaped to give the nose a more natural contour. This treatment is very quick to do, causes very little discomfort and has almost no downtime. The fillers will last at least one year, and often considerably longer. Some people even use this temporary treatment to see if they want to go ahead with surgery later. Hope this helps.

Q. A friend of mine was talking about something called Voluma and a Soft Lift. She had it done and looks great. Can you tell me something about it? J.S.

A. First off, Voluma is a relatively new hyaluronic acid filler from Juvederm. What makes it different is that it is a denser product so it supports tissues well (and likely will last longer too). The Soft Lift is a term employed when we use fillers to restore volume to the face. The fillers are injected in the anatomical fat pads of the face which tend to fall with aging due to the effects of gravity. By restoring the volume, you take the shape of your face back to your younger look naturally giving a soft, natural appearance. Now, Voluma allows an even better lifting effect which should last2-3 years or maybe more. That is why you often hear the two terms used together.

Q. Last week, on CTV, I saw a program about a procedure to fix nose shape with fillers. I don’t like the bump in my nose so I was wondering if this can be done and where I can get it done.

A. Dr. Steve Mulholland in Toronto, pioneered this procedure that he calls the ‘5 minute nose job’. Actually, it takes a little longer than 5 minutes but it is quick and quite easy, using fillers like Juvederm to change the shape. This creates a very pleasing change to the shape of the nose and can correct bumps or hollows very nicely. Unlike surgery, this is minimally invasive but, of course, shorter lasting with a duration of about 2 years.

As for where you can get it done, I am pleased to say that I have done Dr. Mulholland’s training course and I can do that for you in my office in Canmore. Call today to schedule a complimentary skin consultation to discuss this procedure.

PEELS

Q. Will a chemical peel improve my stretch marks?

A. there is no evidence that you can get improvement in the appearance of stretch marks from chemical peels. Nothing really works perfectly for this very annoying cosmetic problem. Lasers are still the best form of treatment. The stretch marks are best treated early, when they are still red coloured. Once they are silvery white, the improvement is minimal. The best treatment is a combination of Intense Pulse Light (IPL) which takes the colour down and laser fractional resurfacing which stimulates new growth. Unfortunately, if large areas are involved, it can get a bit pricey.

Q. I hear a lot of talk about facial SKIN PEELS. Can you give me a bit more information on what they are? L.S.

A. Neat question as I have just written an article on peels in my newsletter. Peels can be very mild with low concentration fruit acid peels such as glycolic acid (often called a ‘lunchtime peel’). With this, you don’t actually peel, rather exfoliate some of the surface dead cells so there is very little recovery. Slightly stronger peels are amazing for treatment pigmentation and acne and will cause some flaking and peeling and possibly slight swelling for about 48 hours.

Microdermabrasion is another form of peeling or exfoliating the skin with no recovery time to speak of. Lasers can be set to remove very precise thickness of skin. A MicroLaserPeel (MLP) will remove as little as 4 microns (0.04mm) of the surface of the skin which is usually very well tolerated and will cause slight redness for about 36 hours. A very quick answer to your question but I hope that it helps.

Q. A friend of mine was talking about something called Voluma and a Soft Lift. She had it done and looks great. Can you tell me something about it? J.S.

A. First off, Voluma is a relatively new hyaluronic acid filler from Juvederm. What makes it different is that it is a denser product so it supports tissues well (and likely will last longer too). The Soft Lift is a term employed when we use fillers to restore volume to the face. The fillers are injected in the anatomical fat pads of the face which tend to fall with aging due to the effects of gravity. By restoring the volume, you take the shape of your face back to your younger look naturally giving a soft, natural appearance. Now, Voluma allows an even better lifting effect which should last 2-3 years or maybe more. That is why you often hear the two terms used together.

ACNE

Q. I have some quite shallow acne scars on my cheeks. My friend told me that I could get rid of these with microdermabrasion. Will that help?

A. Microdermabrasion has been around for a long time. Before microdermabrasion, ordinary sand paper was used to reduce the skin layer to help improve rough texture and spots. Microdermabrasion allowed a gentler, more controlled way of doing this. There are two types of machine – one which uses crystals and the other which has a diamond tip. With both, the treatment involves the removal of the surface layer of the skin. The limiting feature of microdermabrasion is the depth of penetration. This will only allow the removal of 2-5 microns of the skin. This leaves the skin feeling very nice and, with repeated use, will improve the skin texture and tone significantly. We recommend treatments about every 2 weeks and there is no recovery time with this treatment. Unfortunately, most acne scars are deeper than microdermabrasion can treat. That is why we usually use lasers for this, as lasers can go much deeper with their treatment, creating a much better result in the appearance of the scars.

Q. I hate it!!!! I’m female and 19 and my face is covered in pimples. I have tried Proactive and other things that are supposed to help but aaaagh! – they’re still there. What can I do? R.B.

A. First off, R.B., realize that you are not alone. Acne affects a large percentage of the population, male and female. Although teenage acne is more common in males, this changes as we get older and many women have frustrating acne well into adult life. Of course, your menstrual cycle plays a big part in this and can certainly make your skin worse before your period. Makeup can affect your skin too as well as sunscreens and other creams that are put on your face. Family ethnic origin can be a major factor also.

Fortunately, there are treatments that are effective at treating acne from topical creams, antibiotics, peels, microdermabrasion and light (laser) treatments. We even have hats that filter the sun’s rays to treat your skin for acne when you are outdoors. To find out what treatment would work best for you, see us for a free consultation and advice on managing this irritating condition.

Q. I’ve been hearing a lot about Fractional Lasers for treating acne scars and wrinkles. What’s it all about and are the treatments successful?

A. This laser resurfacing procedure is used to improve a wide variety of skin conditions by creating thousands of microscopic channels in the skin surrounded by areas of healthy untreated skin. The zones of untreated skin invigorate the body’s natural healing process and the treated areas stimulate the production of new collagen. The ProFractional Laser treats conditions such as wrinkles and fine lines, post traumatic scars, freckles, age spots, aging and sun damaged skin, sun spots, and acne scars. This means beautiful results for these conditions with very little ‘down time” (2-3 days). We have already seen dramatic results with this laser treatment. Call for your consultation with Dr. Balharry.

PRODUCTS

Q. I see a lot of advertising about Latisse for growing longer eyelashes. Does it really work and how do I get it?

A.Latisse is the only product available that does grow the length of eyelashes. Latisse is a medication that is used IN the eyes for treating glaucoma. People using it for glaucoma noticed that their eyelashes were growing and sometimes had to be trimmed! For this treatment, though, we apply the Latisse OUTSIDE the eye, on the eyelid. Over about six weeks, it will make the lashes grow longer, thicker and often darker. So, yes, it definitely does work. As it is still considered a prescription medication, it can only be obtained through a doctor’s office. This allows us to review side effects and the safe application of the product giving you freedom of mind while you grow those lovely long lashes that are so desirable. See us today – we always have stock of Latisse.

Q. Summer is coming which means shorts and swimsuits. I used to tan at a salon before Summer so that I didn’t look soooo white! But, from all I have been reading it seems that this may not be such a good idea. So how can I not look so white but reduce the risk of tanning?

A. I You are right about artificial tanning. The tanning beds use UVA mostly, which is known to increase the risk of melanoma and eye damage (if not protected). Very occasional use may not significantly increase the risk so a small number of short interval treatments may be OK. Remember, though, that this tan will not protect you from UVB and from infrared injury to your skin. To reduce the risk of tanning, we recommend self tanning. Now, this used to be awful with poor colour and often streaky. The newer products, particularly St. Tropez can provide a safe very natural looking colour that you can apply in your own home prior to those Summer days on the beach. Again, remember that they do not protect your skin so to reduce the risk of skin cancer and aging, still use a good sun protection. Try St. Tropez – you will be amazed!

Q. Wow!! Suddenly it’s 20 degrees and I want to pull on my shorts but aaaaagh! – white, white legs – doesn’t work! I know that tanning beds are not good for you, so is there anything that you can suggest to help?

A. There has been a lot of activity recently in the media about the risks associated with tanning beds, particularly for young people. So why not use a safe tan? Safe tans can be applied as a spray on in a stand up unit, or you can do it yourself at home. We have found St. Tropez to be an excellent product for this. With a careful but simple application process, you can get a very natural looking tan colour and you can control how dark you want it to be. Like all self tanners, there is a bit of an odour that lasts for a few hours, but certainly much less than many and the colour is amazing – no orange look at all. The beauty of the home treatment is that you canapply it every week or so to maintain a nice glow without the risks of sun exposure or tanning beds. Drop in, pick some up and try it for yourself. You’ll be delighted.

Q. I get a lot of questions about general skin care – what to use for a cleanser, toner or moisturizer and what is the difference between one brand or another. So, I am bunching all these questions together here.

A. First off, we don’t all have the same skin. Our skin type tends to relate to where our forefathers lived in relation to the Equator. People living in the Northern latitudes have pale, red skin which tends to be thinner and dryer skin. The closer to the Equator, the darker the skin gets and the more natural oil glands. Even those two skin types require different skin care. Then we throw in all the other factors such as environment, lifestyle, diet and mixed genetic factors and you can understand why one skin cream does not work for all. In Alberta, we have a harsh climate with long, often dry winters but quite different summers. So, even for the same skin, what is good for the summer months may not be nearly good enough for the winter months. You can arrange a complimentary consultation at our MediSpa to talk with Leslie about proper skin care for your type of skin. We can explain the difference between store bought products and cosmeceuticals (therapeutic level cosmetics). We also have many samples that can be used to help you decide what you like before you buy. Don’t lose out – get that advice today – it could save you in the long run.

Q. I have always wanted long eyelashes. Mine are kind of puny. I have heard about Latisse but I don’t know anything about it. Is it safe and does it work?

A. Latisse is a lovely product and YES, it most certainly does work! The chemical in the Latisse eyedrops is used IN the eye for glaucoma. People started to notice that when they were using it, they often ended up having to cut their eyelashes as they were rubbing on their glasses! Now, the same drops are used but NOT IN THE EYE. They are used like eyeliner on the skin of the upper eyelid only. After applying for a few weeks, the lashes grow in length, thickness and often darker in colour. Some people will get a bit of skin irritation but this usually goes away after a few applications. As the drops are not being put in the eye, they are risk free. The only side effect apart from irritation that has been noticed rarely, is pigmentation of the skin where it is applied. Most women do not mind this as it just looks like an eyeliner. So, to answer your question, they do work and they are safe. As this is essentially a prescription item, it must be obtained through a Doctor’s office with consultation first.

Q. I have really short eyelashes which don’t look much better even with mascara. I’ve heard about a product called Latisse that can make your lashes longer. Is this right? K.N.

A. This is absolutely right! Latisse is a prescription only product that does what it claims. It stimulates the growth of the eyelash, making it thicker, longer and usually darker. Because it is prescription, you can only get it from a Doctor’s clinic. During that time, we advise you how to use it properly.

It will usually take about 6 weeks to get the length and then you just use it once or twice a week to maintain the length. The risks will be explained to you but are very minor consisting of skin irritation or, rarely, some hyperpigmentation or darkening of the skin where it is applied. Latisse is also safe for most age groups. Make an appointment and talk to us about it. You’ll be thrilled.

Q. You keep talking about the difference between sunscreens and sunblocks but I am not sure that I have really been able to understand the difference. I have always used a day cream with SPF 15 that I put on in the morning. Is this not good enough?

A. At least you are doing something to protect your skin from early aging effects from the sun. Blocks and screens work differently. Sunscreens include chemicals that help the skin to absorb the damaging effects of the sun, particularly UVA. They should, however, be applied at least 30 minutes before sun exposure to work into your skin and need to be reapplied about every 2-3 hours to maintain their effect.

Sunblocks contain minerals like iron, titanium, zinc and others that block the sun’s rays from your skin. They don’t need to be applied early and will usually last on your skin a lot longer. They also protect against the damage from UVA and the sunburn effect from UVB. So, it is a matter of personal choice, but we recommend the mineral blocks for superior protection.

Q. I saw your answer last week about the sunblocks and sunscreens. Where do I get sunblocks as I don’t see them that often in stores besides the shelves full of sunscreens?

A. Many years ago, sunblocks were quite popular because they looked like ‘war paint’. That was the white stuff that people would apply to their nose or other parts. Then they came out with wild fluorescent colours. Then, that died. This, though, was zinc oxide cream which worked well but nobody wanted to walk about with a solid white face. The mineral blocks then came out from some of the high end makeup companies. They used special techniques to disguise the whitening effect and are applied like a makeup to the face. The good ones require colour matching to your skin tone. But, even for men, when applied with a brush and sprayed, it is completely inconspicuous yet gives great protection. That is what I wear in Mexico or on the golf course. So, you will have to find them in a high end salon or medical spa.

HAIR REMOVAL

Q: I know that Summer is coming up. Is it too late to do laser hair removal on my bikini area? Shaving always gives me red bumps on my skin which I hate in a bikini or shorts.

A: We get asked this question almost every Spring. For long term or permanent hair removal, it takes at least six treatments spaced about 6-8 weeks apart so, no, you can’t get permanent removal before the Summer. BUT – when you treat the bikini area with laser, you will kill some of the hair, and the new hair that grows in is finer and soft. This means that you will not get shaving bumps even if you do have to shave in between, as the hair is not short and thick. It is important that your skin is not tanned so, if you want these results, you should start treatment before you get your legs tanned. Also, remember that active tanning can age your skin, so protect your skin as much as possible from the harsh ultraviolet rays.